沙库巴曲缬沙坦治疗维持性血液透析合并心力衰竭的临床疗效  

Clinical efficacy of angiotensin-receptor neprilysin inhibitors in the treatment of maintenance hemodialysis with heart failure

作　　者：孙长丽 董洋 王丽姣 赵心迪 张翥 邵凤民[1] Sun Changli;Dong Yang;Wang Lijiao;Zhao Xindi;Zhang Zhu;Shao Fengmin(Department of Nephrology,Henan Provincial People's Hospital/l China Fuwai Hospital/Henan Provincial Clinical Research Center for Kidney Disease/Henan Key Laboratory of Nephrology and Immunology/Department of Nephrology,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院肾内科,华中阜外医院肾内科,河南省肾病临床医学研究中心,河南省肾脏病免疫重点实验室,郑州大学华中阜外医院肾内科,郑州450003

出　　处：《中华肾脏病杂志》2022年第1期15-22,共8页Chinese Journal of Nephrology

基　　金：国家重点研发计划(2018YFC1311202)。

摘　　要：目的观察沙库巴曲缬沙坦(angiotensin-receptor neprilysin inhibitors,ARNI)治疗维持性血液透析(maintenance hemodialysis,MHD)合并心力衰竭患者的临床疗效。方法回顾性收集2019年10月至2020年10月在华中阜外医院行MHD治疗且合并心力衰竭的患者的一般临床资料,在常规治疗的基础上,其中治疗组患者加用ARNI,对照组患者加用缬沙坦胶囊,治疗6个月,分别收集并比较治疗前后心功能相关指标,如左室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期内径(left ventricular end-diastolic dimension,LVEDD)、左心室收缩末期内径(left ventricular end-systolic dimension,LVESD)、肺动脉压、右心室舒张末期内径(right ventricular end-diastolic dimension,RVED)、右心房舒张末期内径(right atrial end-diastolic dimension,RAED)、N末端前B型利钠肽(N-terminal pro-B-type natriuretic peptide,NT-pro BNP)及血钾等。采用多元有序Logistic回归分析法分析患者治疗疗效的影响因素。结果本研究共纳入60例MHD合并心力衰竭患者,年龄(53.92±11.88)岁,男性37例(61.7%),透析龄(27.83±12.92)个月,血压(154.22±15.27)mmHg/(85.43±12.31)mmHg。(1)治疗组(n=30)和对照组(n=30)患者治疗前临床资料及心功能指标差异均无统计学意义(均P>0.05);(2)治疗6个月后,治疗组总有效率[28/30(93.3%)]显著高于对照组[20/30(66.7%)],治疗组再住院率[2/30(6.7%)]显著低于对照组[10/30(33.3%)](均P<0.05);(3)治疗6个月后,两组LVEF、LVEDD、LVESD、肺动脉压、RVED、RAED、NT-pro BNP及血压水平较本组治疗前均明显改善(均P<0.05),体重及血钾水平在治疗前后均无明显变化(均P>0.05);(4)治疗后治疗组LVEF高于对照组,LVEDD、LVESD、肺动脉压、NT-pro BNP及血压水平均小于对照组(均P<0.05);两组治疗后RVED、RAED、血钾及体重差异均无统计学意义(均P>0.05);(5)两组治疗前后各项指标的差值比较中,LVEF、LVEDD、LVESD、NT-pro BNP、体重、收缩压及舒张Objective To observe the clinical efficacy of angiotensin-receptor neprilysin inhibitors(ARNI)in the treatment of maintenance hemodialysis(MHD)with heart failure.Methods The clinical data of heart failure patients who accepted MHD in Central China Fuwai Hospital were retrospectively collected.All patients accepted regular treatments of heart failure,and then the treatment group was treated with ARNI,while the control group was treated with valsartan.The treatment course was 6 months.The cardiac parameters:left ventricular ejection fraction(LVEF),left ventricular end-diastolic dimension(LVEDD),left ventricular end-systolic dimension(LVESD),pulmonary artery pressure,right ventricular end-diastolic dimension(RVED),right atrial end-diastolic dimension(RAED),N-terminal pro-B-type natriuretic peptide(NT-pro BNP),and serum potassium were collected and compared between the two groups.Multivariate ordered logistic regression analysis was adopted to analyze the influencing factors of treatment effect.Results A total of 60 MHD patients with heart failure were enrolled with age of(53.92±11.88)years old,37 males(61.7%),dialysis age of(27.83±12.92)months,and blood pressure of(154.22±15.27)mmHg/(85.43±12.31)mmHg.(1)There was no significant difference of the clinical data and cardiac parameters between the treatment group(n=30)and the control group(n=30)before treatment(all P>0.05);(2)After treatment of 6 months,the total effective rate[28/30(93.3%)]in the treatment group was significantly higher than that in the control group[20/30(66.7%)]and the rehospitalization rate[2/30(6.7%)]in the treatment group was significantly lower than that in the control group[10/30(33.3%)](both P<0.05);(3)After treatment of 6 months,LVEF,LVEDD,LVESD,pulmonary artery pressure,RVED,RAED,NT-pro BNP,and blood pressure were all improved significantly compared with the baseline in both groups(all P<0.05)and there was no significant difference of serum potassium and body weight before and after treatment in the two groups(all P>0.05);(4)After treatme

关 键 词：缬沙坦 肾透析 心力衰竭 沙库巴曲缬沙坦 疗效 安全性 

分 类 号：R459.5[医药卫生—治疗学] R541.6[医药卫生—临床医学]